Afever hospital orisolation hospital is ahospital forinfectious diseases such asScarlet fever,Tuberculosis,Lassa fever andSmallpox. Their purpose is to treat affected people whileisolating them from the general population. Early examples included theLiverpool Fever Hospital (1801) and theLondon Fever Hospital (1802).[1]: 13 Other examples occurred elsewhere in the British Isles and India.
The hospitals became common in England when laws were passed at the end of the 19th century, requiring notification of infectious diseases so that public health officers could ensure that the patients were isolated. During the 20th century,immunisation andantibiotics reduced the impact of these diseases.[2] After the introduction of theNational Health Service in 1948, the hospitals were wound down so that, by 1968, there were few left.[1]: 27
As a result of theCOVID-19 pandemic a number of temporary isolation wards within existing hospitals were established as well as several temporary hospitals,[3] such as thenightingale hospitals in England which were little used in many countries with the notable exception of China.[4]
It has been suggested that creating modern isolation hospitals might be an effective way of managing highly infectious diseases as was shown in China during the COVID-19 pandemic.[4] however the lack of staff to operate these facilities, the large costs for no ongoing direct patient benefit and the inability to use other hospital facilities to provide care for patients have been cited as the key reasons why fever hospitals are not appropriate in modern healthcare.[5]
The first hospital specifically for smallpox was theLondon Smallpox Hospital, founded in 1741. The first specialist hospital for other infectious diseases was theLiverpool Fever Hospital which was founded in 1801. Fever hospitals or "houses of recovery" were then established in other major cities – Chester, Hull, London,Manchester, Newcastle upon Tyne and Norwich. These were mainly for the treatment oftyphus which was common.[6] By 1879, isolation hospitals of some sort were established in 296 local authorities, out of a total of 1,593 – about 18.5%. As thegerm theory of disease and nature of infection became established, more fever hospitals were established so that, by 1914, they were the most common sort of hospital.[1]: 20 The numbers and sizes of the different sort of institutions at that time were[1]: 20
| Institution | Average size (beds) | Number in England and Wales |
|---|---|---|
| Fever hospital | 41 | 755 |
| Poor Law infirmary | 134 | 700 |
| General hospital | 53 | 594 |
| Smallpox hospital | 22 | 363 |
| Specialist hospital | 62 | 222 |
After the London Fever Hospital was established in 1802, six more hospitals were established in London by theMetropolitan Asylums Board. These were designed with two separate buildings – one forsmallpox patients and one for sufferers from other infectious diseases:cholera,diphtheria,dysentery,measles,scarlet fever,typhoid fever,typhus andwhooping cough.[7]: 23
In London, there were protests and legal action against fever hospitals by residents who were concerned about the risk of infection. Precautions were taken, such as disinfection of ambulances, but it was found that the incidence of smallpox increased near smallpox hospitals. Siting of the hospitals next to rivers, so that transport of patients could be limited toambulance steamers was found to reduce this. Ships, moored on the Thames atLong Reach, were also used as isolation hospitals.[8]
The UKInfectious Disease (Notification) Act 1889 (52 & 53 Vict. c. 72) required that local authorities be notified of the occurrence of such infectious diseases. The medical officer of health was then empowered to isolate the patients to prevent spreading. Well-to-do patients could be isolated at home but poorer people lacked the facilities and space for this. The requirement for isolation thus drove the need for provision of hospitals for this purpose. These measures were compulsory in the London area and were made compulsory in the rest of the country by theInfectious Disease (Notification) Extension Act 1899 (62 & 63 Vict. c. 8).[9]
Cross-infection was a significant issue because patients with different diseases might be put in the same ward and share facilities such as towels. Isolation hospitals were then criticised as places "where a person goes in with one infectious disease and catches all the rest."[9]: 4 Patients returning from such hospitals might then spread the acquired infections to members of their families. These were called return cases and they could result in complaints and lawsuits. A major difficulty was a lack of understanding of scarlet fever, which was the most common disease at that time. The nature of the disease and how it was transmitted was uncertain. To prevent return cases, hospitals tried extending the period of isolation and giving patients disinfectant washes withformalin orLysol when discharging them.[9]